Indoor Pollution Close to Home: Dr. Mildred Maisonet and her Research
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Dr. Mildred Maisonet speaks with graduate student Titilayo James at East Tennessee State University.Photo: Brittnee Nave

A burning log in the fireplace may produce a pleasant smell, but this method of warming a home in the winter may present risks to people with respiratory problems. Smoke, whether from wood, coal or tobacco products, gives off particles in the air that are considered household air pollutants.

A new five-year study looks at how those airborne particles affect patients with chronic obstructive pulmonary disease, or COPD, who live in rural and urban areas. The patients will be visited three times over a span of six months, and monitors will be placed in their homes to look for toxins in the air. Dr. Mildred Maisonet, a professor at East Tennessee State University, leads the rural side of the study.

According to the COPD foundation, COPD is a term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. People with this disease generally have symptoms like increased coughing and breathlessness.

“We live in an area where ... tobacco smoke, and burning of solid fuels like wood or coal for cooking and heating, are major sources of household contaminants,” Maisonet said.

Originally from Puerto Rico, Maisonet has worked at ETSU since 2014 in the biostatistics and epidemiology department. As an epidemiologist, she studies disease occurence and its causes, using this information for disease prevention and control.

Maisonet's previous research has included the impact chemicals have on female reproduction, including menarche, or a girl's first menstrual period. According to Maisonet, this research is important for maintaining the human species.

"For women, one of the most important things in the world is being a mother," she said. "When you have fertility problems and they can be explained by environmental factors, we can recommend modifications to prevent them."

She began her study of household air pollutants and COPD morbidity after moving to Johnson City, Tennessee, to work at ETSU.

"As I came to Johnson City, I found a lot of things I wasn't expecting to find," she said. "Two of the concerns I had were the level of poverty and the lack of education about indoor pollutants."

“We live in an area where ... tobacco smoke, and burning of solid fuels like wood or coal for cooking and heating, are major sources of household contaminants.”

– Mildred Maisonet

After being invited to participate in the indoor pollution research project, she found that she could address these concerns.

The research project is part of a $1.5 million grant, and 100 people were projected to participate in the study. As of now, the research has been underway for a couple of months and has enrolled 15 participants.

Maisonet’s alma mater, Johns Hopkins University School of Public Health in Baltimore, Maryland, will be partnering with ETSU on the project.

Maisonet has been interested in science from an early age, and said it was her favorite subject in school.

“I have always been interested in learning how things worked,” she said. “I was always very enthusiastic about math and science for as long as I can remember.”

In college, Maisonet also liked computer programming, and wanted to incorporate her interests in both. Upon reading “Medical Detectives” by Berton Roueché, which included stories about diagnosing diseases in a population, she was fascinated. At that point she decided to become an epidemiologist. She also learned biostatistics, because of her interest in computer technology.

She earned both her bachelor's degree in biology and her master’s degree in epidemiology at the University of Puerto Rico.

After college, Maisonet began an internship working for the Centers for Disease Control and Prevention in 1998, which soon turned into a permanent position. She worked in the Agency of Toxic Substances and Disease Registry at the CDC, where the focus was to protect communities from harmful health effects related to exposure from dangerous natural and man-made substances.

In 2001, she earned her doctorate degree in epidemiology at Johns Hopkins.

“I loved my professors at Johns Hopkins,” she said. “They were people with a lot of experience that you get over years and years, and were very knowledgeable. They all worked together and coordinated the work that they gave us.”

Maisonet appreciated the diverse population of the school.

“It was nice to be able to acquire knowledge about other cultures while I was getting my doctorate, and to have made friends there that will probably last a lifetime,” she said.

Besides working for the CDC and the Pan American Health Organization, Maisonet collaborated with the Rollins School of Public Health in Atlanta from 2003 to 2006, and worked for the University of Oulu in Finland as a lecturer for 18 months. She moved to East Tennessee after that.

Kenneth Silver, an associate professor of environmental health at ETSU, met Maisonet when she started at the university three years ago. Since then, the two have worked together on projects.

“From the get-go, I was keenly interested in encouraging an environmental epidemiologist with her excellent credentials to get collaborative studies going,” he said. “We speak the same language of epidemiologic study designs, the feasibility of working with regional populations and the desirability of involving members of the community.”

Maisonet’s research with indoor toxins is supported by both the Department of Epidemiology and the Department of Environmental Health.

She and Silver also worked as co-investigators for the Tennessee Board of Regents’ “Train the Leaders” project. This initiative sponsored last summer’s Environmental Health Leadership Health Institute for 28 area Hispanic high school students.

“I love the fact that it is a collaboration between our two departments, epidemiology and environmental health,” Silver said. “Scientifically, the team is asking important questions about a common disease in middle-aged and older people.”

The U.S. Department of Health and Human Services reports that approximately 12 million adults in the U.S. are diagnosed with COPD, and 120,000 die from it each year. An additional 12 million adults in the U.S. are thought to have undiagnosed COPD.

According to Silver, the indoor toxins research could be beneficial not only to the local community, but also ETSU.

“With the involvement of Mildred’s peers at Johns Hopkins, the study is putting ETSU on the map, so to speak, for future studies of environmental health issues affecting our local population,” Silver said.

Maisonet has tips for those hoping to reduce the amount of indoor toxins in their homes. She suggests testing the home, making cleaning supplies from recipes online and avoiding fragrances.

"For fragrances like perfume, they are made up of chemicals that we do not know," she said. "They are protected by property laws. So if you have a perfume, no one knows what's in it because that is something companies don't want getting out there. They don't want people getting their recipe and copying it."